How is osteoporosis treated?

Treatments for established osteoporosis may include exercise, vitamin and mineral supplements, and medications. Exercise and supplementation are often suggested to help you prevent osteoporosis. Weight-bearing, resistance and balance exercises are all important.

What medications are used to treat osteoporosis?

There are several classes of medications used to treat osteoporosis. Your healthcare provider will work with you to find the best fit. It’s not really possible to say there is one best medication to treat osteoporosis. The ‘best’ treatment is the one that is best for you.

Hormone and hormone-related therapy

This class includes estrogen, testosterone and the selective estrogen receptor modulator raloxifene (Evista®). Because of the potential for blood clots, certain cancers and heart disease, estrogen therapy is likely to be used in women who need to treat menopause symptoms and in younger women.

Testosterone might be prescribed to increase your bone density if you are a man with low levels of this hormone.

Raloxifene acts like estrogen with the bones. The drug is available in tablet form and is taken every day. In addition to treating osteoporosis, raloxifene might be used to reduce the risk of breast cancer in some women. For osteoporosis, raloxifene is generally used for five years.

Calcitonin-salmon (Fortical® and Miacalcin®) is a synthetic hormone. It reduces the chance of spine fractures, but not necessarily hip fractures or other types of breaks. It can be injected or it can be inhaled through the nose. Side effects include runny nose or nosebleed and headaches for the inhaled form. Side effects include rashes and flushing for the injected form. It is not recommended as a first choice. There are possible more serious side effects, including a weak link to cancer.

Bisphosphonates

Bisphosphonate osteoporosis treatments are considered antiresorbtive drugs. They stop the body from re-absorbing bone tissue. There are several formulations with various dosing schemes (monthly, daily, weekly and even yearly) and different brands:

  • Aledronate: Fosamax®, Fosamax Plus D®, Binosto®.
  • Ibandronate: Boniva®.
  • Risedronate: Actonel®, Atelvia®.
  • Zoledronic acid: Reclast®.

You may be able to stop taking bisphosphonates after three to five years and still get benefits after you stop. Also, these drugs are available as generic drugs. Of these products, Boniva and Atelvia are recommended only for women, while the others can be used by both women and men.

Possible side effects of bisphosphonates include flu-like symptoms (fever, headache), heartburn, and impaired kidney function. There are potentially serious side effects also, such as the rare occurrence of jaw bone damage (osteonecrosis of the jaw) or atypical femur fractures (low trauma fractures of the thigh). The risk of these rare events increases with prolonged use of the medication (>5 years).

Biologics

Denosumab (Prolia®) is product that is available as an injection given every six months to women and men. It is often used when other treatments have failed. Denosumab can be used even in some cases of reduced kidney function. Its long-term effects are not yet known, but there are potentially serious side effects. These include possible problems with bones in the thigh or jaw and serious infection.

Anabolic agents

These products build bone in people who have osteoporosis. There are three of these products currently approved:

  • Romososumab-aqqg (Evenity®) has been approved for postmenopausal women who are at a high risk of fracture. The product both enables new bone formation and decreases the breakdown of bone. You will get two injections, one right after the other, once per month. The time limit is one year of these injections.
  • Teriparatide (Forteo®) and Abaloparatide (Tymlos®) are injectable drugs given daily for 2 years. They are parathyroid hormones, or products similar in many ways to the hormones.

When should osteoporosis be treated with medication?

Women whose bone density test shows T-scores of -2.5 or lower, such as -3.3 or -3.8, should begin therapy to reduce their risk of fracture. Many women need treatment if they have osteopenia, which is bone weakness that is not as severe as osteoporosis. Your doctor might use the World Health Organization fracture risk assessment tool, or FRAX, to see if you qualify for treatment based on your risk factors and bone density results. People who have had a typical osteoporosis fracture, such as that of the wrist, spine or hip, should also be treated (sometimes even if the bone density results are normal).

Supplements

It’s important to remember that dietary supplements, although available everywhere over-the-counter and online, aen't regulated in the same way that prescription medications are. Also, even though something is ‘natural,’ that doesn’t mean that it is safe for everyone at all times.

You might be told by your healthcare provider to get adequate amounts of calcium and vitamin D. This is important if you have osteoporosis or if you are trying to prevent it. It’s best if you can meet those needs with a food plan, but you might not be able to do that. There are plant-based calcium supplements, some of which are based on algae.

The recommended amount of daily calcium intake is 1,000 mg to 1,200 mg daily via diet and/or supplements. Taking more than this amount of calcium has not been shown to provide additional bone strength but may be associated with an increased risk of kidney stones, calcium buildup in the blood vessels and constipation.

There are different ideas about the necessary levels of vitamin D, but it’s true that many people do not have adequate levels and might need to take supplements. Your healthcare provider might test your blood levels and then make recommendations based on these results.

There are other supplements that have been touted as useful for osteoporosis. One of these is strontium, which has never been approved in the U.S. for osteoporosis. A prescription version of strontium ranelate had been available in the E.U., but it was taken off the market due to serious side effects.

You and your healthcare provider will always need to discuss whether the benefits of taking something, whether is a prescription drug or a supplement, outweigh the risks.

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